Name:
John Bernard Kennedy
Bursary Application Package
THE JOHN BERNARD KENNEDY TRUST BURSARY
In May 2001 the Simcoe County District School Board was advised that the late John Bernard Kennedy had included a bequest in his will to provide scholarships for graduating students of ElmvaleDistrictHigh School. The will directed the Simcoe County District School Board, through its Scholarship and Trust Fund, to provide scholarships “to benefit those who may not otherwise be able to afford to attend a post secondary educational facility”. Scholarships, totaling ten thousand dollars, will help the recipients pay for a significant portion of their first year expenses. Graduating students who are proceeding to post-secondary education are eligible to apply for the bursary.
Instructions:
** Please print a copy of this application, complete it fully, and submit it to Mrs. Georgy-Jenkinson.
** Paper copies of the application and all supporting documentation must be submitted by the due date:
Wednesday, June 7, 2017 @ 3:30 pm:Deadline for submitting completed applications
to Student Services; no new applications will be accepted after this deadline
The bursaries will be awarded upon confirmation that the student has accepted an offer of admission from a recognized post-secondary educational institution.
Applicants will be required to provide information on their potential sources of revenue (current part time work, summer employment, etc.). Parents/Guardians will be asked to provide additional financial information to assist the selection committee in determining which applicants demonstrate the greatest financial need. This information will only be shared with members of the selection committee. All application material will be shredded six months after the bursary is presented.
THE JOHN BERNARD KENNEDY BURSARY
Application Form
SECTION A:Personal Information
Student’s Full Name______
Permanent Ontario Address______
______
Telephone Number:______
E-Mail Address______
SECTION B:Family Information
Please describe your current living arrangement:______
______
Do you have siblings?_____YES_____NO
If YES, please complete the information below:
Name / Age / School (if attending) / Employer (if full time)SECTION C:Post-Secondary Information
Provide the name of the post-secondary institution at which you have accepted an offer of admission, and its location.
Which campus or college of the above institution will you be attending (if applicable)?
What is the name of the program? ______
How long will it take you to complete this program and graduate (in years)? ______
What will you graduate with (name of degree, diploma or certificate)?
Will you be attending:
_____Full time
_____Part time
_____Taking this program through online courses or an alternate delivery method
Is this a co-operative education program?_____YES_____NO
During your first year at school, where will you be living?
_____At home
_____With other family members at another location
_____In residence
_____Sharing an apartment / off-campus housing
_____ Other: ______
What do you anticipate will be your MONTHLYexpenses for:
Housing and meals? ______
Transportation? (car payments, gas,insurance, servicing, bussing, etc.) ______
What are your anticipated academic expenses for the upcoming year?
______Tuition
______Textbooks
______Other program-related expenses
SECTION D:Personal Financial Information
Please provide accurate estimates of earnings. All information will be kept confidential.
Do you currently have a part time job?_____YES_____NO
If YES, provide a brief description:
______
______
How many hours did you work in an average week during the school year? ______
What is your average weekly take home pay? ______
Do you anticipate that this job will provide 30-40 hours of work per week during the summer months? _____YES _____NO
If NO, do you have another summer job arranged? Please provide details:
______
Over the two summer months, how much do you think you will earn (before taxes)? Of that, how much money do you plan to save for your post-secondary education?
Earnings ______Savings ______
During the upcoming school year, will you have income from any of the following sources? (check off those that apply)
_____Employment Insurance_____Family Benefits
_____Income from Children’s Aid_____Canada Pension Plan
_____Aboriginal Student Support Programs_____Ontario Works
_____Part-time job_____Other: ______
Estimate the monthly income from these sources: ______
Please list all other Scholarships, Bursaries, Awards or Work Study Programs you have applied for:
NameAmount Received
______
______
______
______
______
Please attach an additional list if needed.
SECTION E:Information from Parents
All information provided in this application will be kept confidential. It will only be shared with the Bursary Selection Committee, consisting of the principal, vice-principal and teachers. All information included in the application will be kept on file until the bursary is presented at Graduation. It will then be sealed and held at Elmvale District High School for six months, after which time it will be shredded.
Family Income:
1st Parent/GuardianLine 150 from 2015 Tax Return $______
2nd Parent/GuardianLine 150 from 2015 Tax Return $______
(if not included with 1st parent)
Please attach a copy of page 2 of each parent’s/guardian’s 2015 income tax return.
How many children, including the applicant, will be attending apost-secondary institution in the upcoming academic year (Sept. – May)? ______
If applicable, please share any special or extenuating circumstances you’d like the Bursary Selection Committee to be aware of.
______
Declaration of Parent/Guardian
I declare that the information provided above is accurate. This information will be used to support my son’s/daughter’s application for the John Bernard Kennedy Bursary. I understand that the information in this application will be destroyed six months after the Bursary is awarded.
______
Parent / Guardian Signature Date